MENTAL HEALTH Flashcards
What are the strengths of diagnostic categories like ICD11?
Standardisation - allows HCP to communicate and share information about pt their conditions accurately and efficiently
Research - diagnostic categories make it possible to study the prevalence, incidence and risk factors of disease and conditions
Treatment planning - allows HCP to make informed decisions about pt care and ensure they receive appropriate treatment
Can assist Organizations and policymakers in resource allocation
What are the limitations of diagnostic categories like ICD11?
Heterogeneity - it can be diffiuclt to capture the full complexity of an individuals health status
Some use DSM so having 2 different criteria sets can make it tricky to know who uses what
It just groups commonly co-existing symptms patterns without understanding the underlying cause
Stigma - can lead to negative social and psychological consequences
Cultural variations in the way illnesses are perceive red and reported
Misdiagnosis as diagnostic categories can be subjective - inappropriate treatment and harm to pt
How do we manage pt who may be potentially violent?
Close observation
Call security and consider need for police
De-escalate and use reasonable restraint to protect staff and patient safety
Consider rapid tranquilisation if all else fails
If pt lacks capacity consider application for DOLS
If mentally unwell refer to psychiatry and consider detainment under MHA
Document incident
Whats the rapid tranquilisation protocol?
Oral lorazepam
Allows at least 1 hour for response and continue non-drug approaches
If this fails or pt refuses give IM lorazepam
Monitor temp, pulse, bp, hydration, conciousness, RR very 15 mins for at least 1 hour and keep them under eyesight observation
What is advocacy?
Getting support from another personal to help express your views/wishes and help stand up for your rights
What is self-advocacy?
This refers to the process of individuals with mental health conditions advocating for themselves by speaking up, seeking support, and asserting their rights and preferences.
What is individual advocacy?
Informal - such as family or friends
Formal - organisations that are paid
What is systems advocacy?
This is about changing policies, laws or rules that impact how someone lives their life.
What is staturoty advocacy?
a person under the MHA or lacking capacity is legally entitled to an advocate because of their circumstances
What is an independant mental health advocate?
An allocated worker to support a pt to allow them to express their views and concerns as well as defend their rights
For those detained under the MHA
What is an independant mental capacity advocate?
An allocated worker to support people who lack capacity to make certain decisions
Provided under the MCA 2005
What is a social care advocate?
Allocated workers to support people under the Care Act 2014
What is the Care Act 2014?
A UK law that sets out the legal framework for how adult social care is provided and funded
What are the roles of an advocate?
Listen to views and concerns of the patient
Help to explore options and rights without advising
Give information to help patient make informed decision
Help patient to contact people, or contact people themselves on your behalf
Accompany and support patient in meetings or appointments
What is stigma?
A mark of disgrace associated with a particular circumstance, quality or person
or viewing someone negatively because of a mental illness
What is discreditable stigma?
Keeping stigmatising conditions hidden except from close family and friends
What is discrediting stigma?
When a stigmatising condition cannot be hidden
What is felt stigma?
Internal stigma - manifests itself as feelings of shame, guilt or depression, and behaviours such as self-stigmatisation, withdrawal from society, and an unwillingness to speak up.
May stop you from seeking help
What is enacted stigma?
the experience of unfair treatment by others i..e discrimination by others
What is courtesy stigma?
Stigma felt by someone who is associated a person open to stigma e.g. a parent of a child with autism
What was the equality act 2010? And how is it relevant to stigma?
a UK law that was enacted to ensure that everyone is treated fairly and has equal opportunities, regardless of their age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, or sexual orientation.
It makes it illegal to discriminate directly or indirectly against people with mental health problems in public services and functions, access to premises, work, education and transport
What proportion of mental health is managed by GPs?
95%!!!
What are the common reasons a Gp will refer someone to secondary care for their mental health?
Moderate to Severe mental illness e.g Schizophrenia, BPD, Severe Depression
Patient at serious risk to themselves or others
Uncertainty regarding diagnosis
Poor response to standard treatment / Specialist treatment required
What is IAPT?
Improving Access to Psychological Therapies
A program in the UK with the aim of improving access to evidence-based psychoglocial therapies for people with common mental health conditions. It’s a key part of the governments strategy to improve mental health services and reduce the burden of mental ill health on individuals and society
Whats the role of the Community mental health team?
This is an MDT of mental health professionals working together to provide care and support for people with complex or severe mental health need in the community
- systematic assessment of patient health or social care needs
- formation of agreed plan to address needs
- allocation of care coordinator to keep in touch with and coordination care with patient
What principles underpin the current organisation of mental health services in the UK?
- person-centred approach
- recovery-orientated care
- evidence-based practice
- rapidly accessible
- range of services functioning as a system
What are the members of the community mental health team?
Psychiatrist
Community psychiatric nurse
Social worker
Support worker
Occupational therapists
Clinical psychologists
Primary health care worker
Team manager e.g. senior nurse or social worker (dont see pt themselves but just run the team)
Whats the role of the psychiatrist?
assess and diagnose pt, prescribe medication, may be involved in administering psychotherapy
Whats the role of the community psychiatric nurse?
A registered nurse
visit pt at home, see pt in out-patient departments, can help co-ordinate care for a pt, can administer medications and monitor effects
Whats the role of the social worker?
A professional who provides support and advocacy for people with mental health conditions
Allow pt to talk through their needs and consider social care implications - includes ensuring patient rights under MHA are consider
Can help with accessing benefits, housing and social care services
Whats the role of the social supporters?
A trained staff member who provides practical assistance and emotional support for people with mental health conditions, including help with daily living tasks, socialization, and leisure activities.
Whats the role of the occupational therapists?
Help improve ADLs, identify what pt can’t do and what support they need to allow them to become independent and regain skills
Help in developing and maintaining their ability to engage in meaningful activities, such as work, hobbies, and self-care.
Whats the role of a clinical psychologist?
A mental health professional who provides psychotherapies
Whats the role of a primary health care worker?
Assess and signpost pt, can also provide them with short-term therapy
What is the crisis team?
Support mental health crises in the community e.g. suicidal thoughts, self-harm, experiencing psychosis, severe panic attacks, putting others at risk
Offer short term support to prevent hospital admission or can arrange for pt to go to hospital if pt is very unwell
May offer medication, arrange regular visits, make sure pt is in touch with other services to get long term support
What is the Early intervention for Psychosis team?
A team that provides early intervention and treatment for individuals experiencing their first episode of psychosis
Provide self-management skills, housing and debt management, employment support, relapse prevention work, psychological and pharmacological interventions, carer’s assessments, crisis plan, regular checks and monitoring
What is the assertive outreach team?
they works with an identified group of service users who have severe mental health problems and aren’t currently engaging effectively with mental health services.
They aim to reduce hopsital admission by helping with family living e.g. taking meds, social support, accessing crisis support quickly,. Care plan for family and friends
What is CAMHS?
Children and Adolescent Mental Health Services
What are forensic teams?
Those that work with those who have committed serious crimes
How have mental health services in the Uk changed in the last 20 years?
Increased funding from government
A shift to focussing on community-based care and a greater emphasis on early intervention and prevention - crisis resolution teams, early intervention for psychosis teams, community mental health teams
There has been a move towards integrating mental health services with primary care
Move to reduce stigma
Increased used of evidence-based treatments a e.g. CBT and meds
Increased focus on recovery and supporting people to lead fulfilling and meaningful lives!
Increased involvement of service users and carers in the planning and delivery of mental health services
Outline the epidemiology of depression?
Leading cause of disability and contributes significantly to global burden of disease
24% women and 13% men diagnosed with depression in their lifetime in England (approx. 1 in 5)
More common in females however more men die by suicide
More common in lower socioeconomic classes and urban areas
Common in pts with chronic conditions
50% of cases occur <40 (peak onset 25-40)
Peak onset is 50-70 for depression with psychotic features
What are risk factors for affective disorderS?
Family History and Genetics
Childhood experiences
Female
Previous mental illness
Trauma, stress, major life events
Physical illness
Personality type (neuroticism/perfectionism/low self-esteem/negative patterns of thinking)
Recent childbirth
Substance misuse
Medications e.g. steroids
Outline the role of mental health teams in the management of depression?
MDT approach is best practice
GP or Psychiatrist - assess and diagnose pt, prescribe pharmacological mx
Psychologist - deliver psychotherapy (CBT most commonly)
Community psychiatric nurse - visit pt in their homes, outpatient departments or GP, give practical advice/support, help with medication and monitor for effects
Occupational therapists - help people get back to doing practical things of everyday life
Social worker - responsible for pt’s care plan approach
Crisis team - suicide attempt/ideation and self-harm
Describe how depressive illness is distributed across sex, social and ethnic groups in the UK
Women are more likely 19% to men 12%
Those from a more disadvantages socio-economic background are at greater risk
the prevalence of self-reported depression was highest among Black adults (22%), followed by South Asian adults (20%), and White adults (16%). However, the prevalence of self-reported anxiety was highest among South Asian adults (23%), followed by Black adults (19%), and White adults (15%).
Ethnicity and depression
Afrocaribbean presrnt less frequently to GPs
Mediterranean tend to present more with somatic sympotms
Chinese make greater use of body language to express distress
Japanese - depression is seen as a black mark and is shameful and stops marriages so pt may not confess
Why can migration be a risk factor for depression?
Language barriers and social isolation
How can culture affect depression
Some cultures where women don’t work / leave house, man works but does nothing for house / kids are more predisposed to depression following death of spouse as role change is significant
Some cultures think shouldn’t grieve as disrespectful; others think should mourn for long time
Some cultures may not accept western theories for depression (biochemical changes) & therefore not accept treatment for it in the way that a practitioner wants to prescribe it
Ethnicity and psychosis
Ethnic minorities, particularly Afro-Caribbean in America have a 4x higher rate of psychosis, whilst Latin Americans have a 3x higher rate
Why is sensory impairment a known risk factor for depression?
Many deaf people feel socially excluded and isolated, which can impact on mental health and also the accessibility of mental health services
May also impact their ability to communicate how they’re feeling
High levels of unemployment which is known to affect psychological wellbeing of the patient
What are healthy adjustment response to physical symptoms?
Seeking medical help
Adopting a healthy lifestyle
Using coping strategies
What are unhealthy adjustment responses?
Denial
Avoidance
Overuse of meds or substance misuse
How can personal factors impact how an individual responds to physical symptoms?
Individual beliefs, personality traits, and coping skills can influence how individuals respond to physical symptoms. For instance, individuals who are more optimistic and have a positive outlook on life may be more likely to adopt healthy coping strategies.
How can family factors impact how an individual responds to physical symptoms?
Family support and dynamics can influence how individuals respond to physical symptoms. For example, a supportive family environment can provide emotional support and encourage healthy lifestyle changes.
How can cultural factors impact how an individual responds to physical symptoms?
Cultural beliefs, norms, and values can impact how individuals perceive and respond to physical symptoms. For example, some cultural beliefs may stigmatize seeking medical help or using medication, which can lead to unhealthy adjustment responses.
What are the aims of health promotion in psychiatry?
- empower individuals and communities to take control o their mental health
- improving QOL
- Raising awareness and reducing stigma
- supporting healthy lifestyles
- building resilience and coping skills
- early intervention and treatment
- education ad training
What are some health promotion strategies for mental health and wellbeing?
Reducing stressors that can cause mental health e.g. better housing, raising minimum wage
Mass media campaigns on the importance of good mental health
Simple coping techniques for stress from GP/school/employers
More education for HCP being aware of potential poor mental health
Advising parenting skills to promote healthy development in children
Education for teachers about noticing issues with children and preventing bullying
School curriculums about resilience, life skills
Promotion of body size aceptance and reducing stigma about cultural or ethnic differences
Education about bad health behaviours e.g. smoking
Tackling parenteral unemployment
Tackling other social and economic inequalities
Early intervention for mental illness
Outline the effects of the normal ageing process and physical illness on mental health?
Cognitive changes can affect mental health
Chronic pain can cause frustration, depression,anxiety
Social isolation as we lose loved ones or find it diffiuclt to maintain social connections
Medication side effects
Physical disability may lead to feelings of helplessness and decreased self-esteem
Loss and grief
What support is there in the community for patients suffering from psychiatric disorders in old age?
Community mental health teams
Dementia support services
Counselling and psychotherapy
Social activities
Telehealth services
Housing support
Care workers
Housekeeping and domestic work
Companionship services
Sitting service na despite care for carers
Old age psychiatric team
What is residential care?
a type of care where individuals live in a residential facility that provides them with personal care and support services. Residential care can be provided for a variety of reasons, including old age, physical disability, and mental health problems.
They have their own private room but share common areas. The facility is staffed by trained care workers who provide assistance with daily activities 24 hours e.g. meals, bathing,meds help
Semi-independant
What is a nursing home?
A 24 hour care facility for highly dependant residents who are unable to care for themselves
The residents have individualised care plans
There are regular doctor visits and lots of nursing Staffa available
Some nursing homes will specialise in one mental health condition e.g. dementia
What are respite care homes?
These homes provide temporary care for individuals who need a short break from caring responsibilities or who require additional support after a hospital stay. Respite care homes can provide a safe and supportive environment for individuals to rest and recover.
What are supported living homes?
These homes provide accommodation and support for individuals with disabilities or mental health conditions who wish to live independently. Staff in supported living homes can provide assistance with daily tasks and help residents to develop the skills they need to live independently.
Whats the difference between residential care homes and supported living homes?
Residential care homes provide accommodation and personal care for individuals who may need help with daily tasks but do not require nursing care.the residents pay for this. usually associated with mental health conditins. Staff in residential care homes are trained to provide support with personal care, meals, and medication, among other things. Residents in residential care homes typically have their own room, and communal spaces are shared with other residents.
Supported living homes, on the other hand, provide accommodation and support for individuals with disabilities or mental health conditions who wish to live independently. Staff in supported living homes can provide assistance with daily tasks and help residents to develop the skills they need to live independently. Residents in supported living homes typically have their own self-contained apartment or bungalow, and they are responsible for managing their own living space and daily routines.
What is the carers (Recognition and Services) act 1995?
UK law that aimed to improve the rights and support for carers of people with disabilities. The main provisions of the Act were:
- introduction of a duty on local authorities to assess needs of carers
- establishment of a duty on local authorities to provider carers with info and advice on services available for them
- provision of a right for carers to request ans assessment of their own needs
- requirement for local authorities to consult with carers whe developing and reviewing social care policies
What are informal carers?
These are family members, friends, or neighbors who provide unpaid care to a person with a physical or mental health condition, disability, or frailty.
What are formal carers?
These are paid professionals who provide care and support services in a variety of settings, including care homes, hospitals, and community settings.
What are respite carers?
These are temporary carers who provide care and support to give the primary carer a break or to cover for a short-term absence.
What is caregiver burden?
the emotional, physical, and financial strain experienced by informal caregivers who provide care to individuals with physical or mental health conditions, disabilities, or frailty. It is a common and serious problem that can lead to negative health outcomes for caregivers and the people they care for.
What factors contribute to caregiver burden?
Increased caregiving responsibilities
Financial strain
Lack of support from family and friends
Limited social interaction and support
Reduced quality of life
Emotional distress
Physical strain
Poor physical health
Limited resources and access to services
What are the consequences of caregiver burden?
The consequences of caregiver burden can include stress, anxiety, depression, social isolation, burnout, and physical health problems. It can also lead to a decline in the quality of care provided and can negatively impact the well-being of the person being cared for.
What are the strategies for reducing the caregiver burden in the UK?
Providing access to respite care
Offering support groups and counseling services
Providing education and training on caregiving skills
Offering financial support, such as carer’s allowances and benefits
Providing access to assistive technology and home adaptations to make caregiving easier
Providing access to healthcare services and mental health support
Improving communication and collaboration between caregivers and healthcare professionals
Addressing systemic issues that contribute to caregiver burden, such as limited access to services and inadequate funding for social care.
What is the carer assessment?
An assessment conducted to identify the impact of caring on the caregivers wellbeing and their ability to continue providing care
It involves things such as financial support required, impact of caring on caregivers personal life and mental health, need for repute care etc
What are the legal rights of carers>
Carer’s Allowance: Carers who are providing care for at least 35 hours a week for a disabled person may be entitled to a Carer’s Allowance from the governmentwhich is 81.90 a week
Flexible working: Carers have the right to request flexible working arrangements from their employers to accommodate their caring responsibilities.
Protection from discrimination: Carers are protected from discrimination by the Equality Act 2010.
Right to a carer’s assessment: Carers have the right to request a carer’s assessment from their local authority or healthcare provider to identify their support needs.
What is the carer’s allowance? Who is eligible?
A benefit provided by the government in the Uk to support carers
To be eligible the carer must provide at least 35 hours of care per week, be at least 16, not in full-time education, not studying for 21 hours a week or more, your earnings are £151 or less a week after tax
It’s currently 81.90 per week
Describe the importance of prevention in child mental health, including normalising of professional or parenteral anxiety when appropriate
- promote healthy development and resilience by encouraging healthy coping strategies and stress management skills
- identifying and addressing risk factors e.g. poverty, violence and trauma
- address parental anxiety or stress as this can impact children’s mental health (normalising parenteral anxiety can hel reduce stigma around mental health and encourage families to seek support when needed)
Promote good sleep habits
Drug and alcohol education
Counselling
Exercise and physical activity
Outline when management of bed wetting is needed and how it’s managed?
Normal for children <6 even if “toilet-trained”
Exclude a physical problem
Educate parent about appropriate toilet training methods
Behaviour therapy e.g. Star chart
Pharmacological treatments used as last resort e.g. nasal, oral, sublingual desmopressin or imipramine
What may cause school refusal?
Refusal to go to school could be due to anxiety in spite of parental pressure
May be a symptom of separation anxiety, social phobia, depression or adjustment disorder
What are protective factors for child mental health?
Secure attachment relationships
Higher intelligence
Good communication skills
Religious faith
Clear, firm and consistent discipline from parent
Wide supportive network of friends and family
Outline the role of the school, health visitors, social services and educational psychologist in managing child mental health
School - identify early signs of mental health problems and provide support or referrals
Health visitors - information and support to parents e.g attachment, parenting skills
Social services - can provide support for families experiencing challenges such as poverty, abuse or neglect which can contribute to MH problems
Educational psychologists - trained to identify and address learning and behavioural problems in children e.g. anxiety, ADHD
Give examples of the impact on carers where the person has complex mental health needs?
Initial impact of diagnosis: fear, anger grief(Determined by understanding, patient’s reaction, nature of relationship)
Long term impact:
Isolation and loss of time to spend with family and friends
Feelings of struggling to cope
Stressed - worrying/caring for someone who is vulnerable 24/7
Neglect own physical and mental needs leading to reduction in well-being
Courtesy stigma
Give examples of the impact on carers where the person is caring for their spouse?
Relationship becomes skewed as one partner becomes less able to contribute in ways such as:
Practically – maintenance of house, chores etc
Companionship
Emotionally
Sexually
Financially
Give examples of the impact on carers where the person caring is a child?
Role reversal
Conflict between family members
If child is young can reduce opportunities for socialising, educational attainment etc
What problems do people with sensory impairment have accessing MH services?
Difficulty communicating with staff including letter and telephone calls
Crisis team often phone consultation
Advice/management may not be applicable to those who are sensory impaired
Psychotherapy is often difficult to conduct
Outline the impact of addiction on society?
Addiction closely follows levels of criminal activities - assault, domestic violence, robbery
Clinics and provisions of medial therapy cost billions
Affects work productivity due to being hungover or having abscences
Large increase in hospital admissions due to alcohol
Outline the impact of addiction on the individual?
Directly or indirectly causes many health conditions
large increase in hospital admissions attributable to alcohol (+ other substance abuse)
Psychological effects - depression very common, schizophrenia associated with heavy cannabis use, long term effects down the line (worthlessness, lack of self-respect)
Outline the impact of addiction on the family?
5 million family members have to deal with problem drinker
Problems include:
Arguments, destruction of relationships
Violence
Debt if loss of job or spent on substance
Promiscuity
Abuse/neglect (can have significant implications for children)
Increased psychological morbidity and primary care attendance for family members
What are the origins of addiction?
Genetics - way you metabolise + how the drugs affects you (we differ in our inherent susceptibility)
Social - peer pressures, family influence (learned acceptable behaviour)
Occupation - high in unskilled labourers
Social stressors - debt, stressful life events
Intellectual disability
Mental illness
Males>females
Availability of drug
What are perpetuating factors for addiction?
Conditioning - taking drug removes negative SE’s of withdrawal (negative reinforcement)
Physiological - tolerance develops - need to increase dose for the same effect
Psychological crutch - becomes a habitual method of dealing with dress (negative coping mechanism)
Social - peers and socialising becomes drug-orientated
What is addiction?
Continued repetition of a behaviour despite adverse consequences
What is dependance?
a cognitive disorder that involves emotional–motivational withdrawal symptoms upon cessation of prolonged drug abuse or certain repetitive behaviors.
What are the symptoms of dependance syndrome?
Salience – substance takes priority over other behaviour
Compulsion – despite negative consequences
Tolerance
Withdrawal upon abstinence
Relief after abstinence
Narrowing of repertoire – neglect of other interests
Reinstatement upon abstinence
What factors make a drug addictive?
Pleasure producing potency
Rapid onset of action
Short duration of action
Tolerance and withdrawal
What maintains addiction?
Personality factors
Social factors
Withdrawal symptoms
What are primary health promotion strategies used to address alcohol and drug abuse?
Educational startegies in school
Mass media campaigns about risk e.g. DRINK AWARE
Government policies including earlier closing times of establishments selling alcohol, banning alcohol advertisement, banning drinking in public places, increasing tax, law for minimum age, illegal recreational drug use, identifying at risk populations
What are secondary health promotion strategies used to address alcohol and drug abuse?
Screening for problem drinkers in clinical encounters
Identifying high risk populations to give advice to
Hep B immunisation
Needle exchange services
What are tertiary health promotion strategies used to address alcohol and drug abuse?
Physical treatment of alcohol and drug related health problems in those with known addiction problems
Psychological treatment in those with known alcohol problems
Fortification of food or prescription of vitamins to ensure better nutritional status
Drug Rehabilitation centres and relapse prevention schemes
Screening for blood-borne viruses
Reduce stigma around getting help
Self-help groups
Court-enforced drug testing and treatment orders
What are the long term social consequences of addiction and substance misuse?
Unemployment
Financial diffiuclties
Relationship breakdowns
Homelessness
Social isolation
Legal consequences
Outline the stages of change model?
Aka the transtheoretical model
Pre-contemplation (no intention on changing behaviour yet)
Contemplation (aware of a problem but no commitment to action)
Preparation (intent on taking action)
Action (active modification!)
Maintenance (sustained change where new behaviours replace old)
Relapse (falling back into old patterns of behavior)
This is an upward spiral where they learn from each relapse
What is motivational interviewing?
A directive patient-centred counselling style that aims to help pts explore and resolve their ambivalence about behaviour change
Four principles:
- Express empathy by using reflective listening to convey understanding of the pt’s point of view and underlying drives
- Develop the discrepancy between the pt’s most deeply held values and their current behaviour
- Sidestep resistance by responding with empathy and understanding rather than confrontation
- Support self-efficacy by building the pt’s confidence that change is possible
How can we use the pre-contemplation stage in the stages of change model to target mental health promotion?
An individual in the precontemplation stage may not be aware of the need for behavior change or may not feel ready to change their behavior. Health promotion strategies for this stage may involve raising awareness of mental health issues and providing information on the benefits of seeking help.
How can we use the contemplation stage in the stages of change model to target mental health promotion?
In the contemplation stage, the individual may be considering making a change but may still be ambivalent about it. Health promotion strategies for this stage may involve providing options and resources for seeking help, such as mental health support groups or therapy.
How can we use the preparation stage in the stages of change model to target mental health promotion?
In the preparation stage, the individual may be actively planning to make a change but may still need support and encouragement. Health promotion strategies for this stage may involve providing specific information on available resources and support for mental health issues.
How can we use the action stage in the stages of change model to target mental health promotion?
n the action stage, the individual is actively making changes to their behavior and may benefit from ongoing support and encouragement. Health promotion strategies for this stage may involve providing practical tools and skills to maintain positive mental health and offering ongoing support and motivation.
How can we use the maintenance stage in the stages of change model to target mental health promotion?
Finally, in the maintenance stage, the individual has successfully changed their behavior and may need support to sustain these changes over time. Health promotion strategies for this stage may involve offering continued support and resources for maintaining positive mental health and preventing relapse.
What non-NHS agencies are involved in managing mental health?
Mind
Samaritans
Childline
Rethink mental illness
Local authorities
Privbator sector providers e.g. counsellors
Education sector
Describe the epidemiology of suicide?
Rates are stable
Highest rates in unemployed, uni students, doctors, lawyers, farmers, policemen
>90% have a psychiatric illness - mostly depression
Women are more likely to attempt but men are more likely to die
most common cause of death in men under 40
Describe the epidemiology of deliberate self harm?
Females more common
More common in young eople
Highest rates in lowest social classes
20% of those with psychiatric illness deliberately self harm
Majority of pt have experiences a major life event
Usually impulsive following a situational crisis
What are risk factors for DSH and suicide?
FHx MH disorder
Chronic physical illness
Previous attempts at DSH/ suicide
Access to lethal methods (vets, pharmacist, dentists, doctors, farmers)
Recent post-discharge period
Specific mental illnesses have a higher rate: anorexia, severe depression, psychosis, BAD, PD, substance misuse
Outline the epidemiology of anorexia nervosa?
Females>Males 10:1
Typical age of onset for female is 16-17, age of onset for male is 12
Equal distribution of social classes - possible some excess in upper/middle class
Outline the aetiology of anorexia nervosa?
Genetic
Psychodynamic models:
- Family pathology - enmeshment (blurring of boundaries), rigidity, over-protectiveness, lack of conflict resolution, weak generational boundaries
- Individual pathology - disturbed body image possibly due to dietary problems in early life, parents’ preoccupation with food, lack of sense of identity
Analytical model - regression to childhood, fixation on oral stage, escape from emotional problems of adolescence
What are some causes of EDs?
Genetics
Family pathology
Control - only part of their life they feel that they can control
Puberty - some pts see it as a way of ‘putting off’ puberty and the demands of it (particularly sexual ones)
Social pressure - society’s influence and public attitude can contribute to mind set of a pt with an eating disorder (particularly in western society)
Depression
Personal characteristics: Low self-esteem, Perfectionism
Emotional distress
Co-morbidities - high incidence of eating disorder in those with DM, CF and other chronic illness
Premorbid experiences - recreational pressure to be slim e.g. gymnast, dancer, sexual abuse, dieting behaviour in family, criticism about weight/eating behaviours
What is the work and families act 2006?
A Uk legislation that introduced new rights and provisions for working parents and carers
It provided additional paternity leave, the right to request flexible working to carers, adoption leave, statutory maternity pay for 39 weeks and the right to take paid time off for antenatal care appointments
(Most relevant bit is that is allows carers to request flexible working hours!
What are the criteria for the carer’s allowance?
Caring minimum 35 hours a week
>16
Care recipient in middle/higher rate of disability living allowance
Cannot be in full time education or be earning >123 pounds a week
<65
What are the risk factors for the development of depression?
FHx depression/ BPAD
Adverse childhood experiences (abuse, relentless criticism, parental loss, perceived lack of affection)
Unemployment
Lower SES
Social isolation
Life events
Physical illness
What are some strategies that individuals may use to manage felt stigma?
Passing
Withdrawing
Covering
Resisting
What is passing in relation to stigma?
The strategy of suppressing one’s stigmatised identity to avoid the negative consequences of stigma i..e not seeking help
What is withdrawing in relation to stigma?
The strategy of disengaging or isolating oneself from social situations and interactions in which one’s stigmatised identify may be exposed
What is covering in relation to stigma?
The strategy of downplaying one’s stigmatised identity in order to avoid negative reactions from others i..e trying to blend in
What is resisting in relation to stigma?
the strategies and actions taken by individuals or groups to challenge or confront stigmatization and discrimination based on identity
Outline the process of stigmatisation?
Labelling = distinguishing differences between people
Stereotyping = making assumptions based on those differences
Prejudice = formation of negative attitudes and beliefs about stigmatised individuals
Othering = separates person e.g. diabetes - diabetics
Discrimination = treating someone differently based on their stigmatised identity e.g. denying health care
What law makes it illegal to discriminate against people with MH problems?
Equality Act 2010
What are some implications of stigma for medicine?
Fear of stigma may act as health-seeking barrier. Doctors judging pt
Concerns about confidentiality and if doctors see their records they will stigmatise
Treatments can lead to stigma
Misdiagnosis
Reduced quality of care
Rescued research funding
Severe depression - detection rate in primary care
Affects up to 20% of attendees
Severe depression , lifetime risk of suicide
10-15%
Whats the purpose of the assertive outreach team?
They work with groups of service users who have severe mental health problems and aren’t currently engaging effectively with mental health services
They support complex mental health needs and aim to prevent you going back to hospital
Note these are no longer available in most areas and you will now get support from the community mental health team
Whats the purpose of the community mental health team?
A community-based team that helps you access psychological therapies, improves physical health care, employment support, personalised and trauma informed care, medicines management and support for self-harm and coexisting substance use
What is the purpose of the crisis team?
They support you if you have a mental health crisis outside hospital and you need urgent mental health support
They offer short term support to help prevent hopsital admission but an arrange for you to go to hospital if you are very unwell
Whats the purpose of the Early intervention in Psychosis team?
They work with you during your first experience of psychosis
Some places only offer services to people under 35 but NICE recommends it to be open to people of all ages
Whats the purpose of forensic team?
provides specialist psychological and psychiatric interventions to assess, treat and manage individuals who, as a consequence of mental illness or personality disorder, have offended, or, present a potential to offend and therefore pose a risk to themselves or others.
When would you need to use thr MHA in a pt with dementia?
section 2 may be used if health professionals think pt are a danger to themselves e.g. if they’re severely neglecting themselves or being aggressive
Section 3 may be used if they need treatment
Try to use this as a last resort if patients would rather be at home then you can arrange help there e.g. an OT and PT assessment to prevent falls
Whats the function of the court of protection?
a court that deals with decisions or actions taken under the Mental Capacity Act.
You would need to apply to the Court if someone needs permission from the Court to make decisions about you.
What are your rights if you have been sectioned?
Right to appeal i.e. ask for discharge or apply to mental health tribunal
Right to get support from an independent mental health advocate
Right to ask for and be told information e.g. what section you are on
Right or refuse treatment under sections 4,5,35,135,136 or if you are under MHA guardianship or conditional discharge
Right to make a complaint through your IMHA
In which situations can you be treated without consent?
Sectioned under MHA
Dont have capacity to decide on treatment
Emergency, life-saving treatment
When do you have the right to refuse treatment?
Living in the community without restrictions
Voluntary pt in hospital
On CTO (unless responsible clinician recalls you to hopsital)
Being treated for a physical HEALT porblem
(unless you lack capacity)
What is Mental Health Units (Use of Force) Act 2018?
The act that makes provisions about the oversight and management of the appropriate use of force(i.e. restraints) in relation to people in mental health units
What are some ways as a doctor you can ensure you have helped a pt with dementia make a decision for himself as much as possible?
Is there a time of day best for the pt e.g. think about sundowning in dementia - maybe they have capacity in the morning?
Could you see the pt at home in a familiar environment
Would having another person present who knows the person well help?
Does the pt require help in understanding the informative given e.g. simple language, pictures, hearing loop, supportive written formation
Are they always this confused? Maybe they have delirium secondary to infection and are more likely to have capacity once this has been treated
What decision making powers does a registered lasting power of attorney for property and affairs have?
The same powers to manage financial affairs as the donor had
Which infections during pregnancy can cause a learning disability?
CMV
Rubella
Toxoplasmosis
Herpes simplex virus
Zika virus
